Chest Pain in a boy with Duchenne muscular dystrophy and cardiomyopathy

Our patient's CMRI findings, in combination with his abnormal ECG findings and elevated troponin I level, led to the diagnosis of acute myocarditis, and his clinical course was consistent with this diagnosis. This case highlights (1) utility of appropriate screening tests to guide further evaluation, (2) the importance of a high index of suspicion formyocarditis in patients withDMD with an acute change in symptoms, and (3) the utility of troponin I levels and novel CMRI techniques in establishing the diagnosis. Although dystrophin deficiency may increase the susceptibility to viralmyocarditis andmyocarditis may hasten the decline in cardiac function, we would caution against the generalization of LGE on CMRI as evidence of myocarditis or prognosticating rapid decline in cardiac function in all boys with DMD. Rather, we believe that it is important to differentiate LGE due to fibrosis and LGE secondary to active myocarditis.